Some young athletes may be facing hidden threats

By BILL PENNINGTON The New York Times

Published: Sunday, May 12, 2013 at 1:00 a.m.

Last Modified: Saturday, May 11, 2013 at 10:16 p.m.

In February, hundreds of youth sports safety advocates convened at a Washington hotel. They were determined to talk about something other than concussions, a counterintuitive ambition considering the rampant worry about the effects of head trauma in young athletes.

David Wilganowski was revived with an automatic external defibrillator after
his heart stopped during a high school football game in Bryan, Texas.
NYT PHOTO / MICHAEL STRAVATO

But the Washington group knew something most do not: the No. 1 killer of young athletes is sudden cardiac arrest, typically brought on by a pre-existing, detectable condition that could have been treated. Another substantial yet hidden lethal threat is heat stroke, a condition considered completely preventable.

A young athlete dies from a cardiac incident once every three days in the U.S., researchers say. In hot months like August, heat stroke often causes the death of a young athlete every other day on average.

Heat stroke has been a focus of sports safety advocates because of simple, common-sense preventive measures, like introducing gradual levels of exercise at the beginning of a sports season in hot temperatures.

Leaders of youth sports acknowledge that concussions have long been overlooked and that the injury deserves a period of heightened awareness, especially because of the potential for long-term consequences. But as the focus of the February conference organized by the National Athletic Trainers' Association suggests, there is a mounting worry that some hazardous health concerns are being disregarded.

One factor that may be inhibiting the conversation is a disagreement about the best course of action to reduce deaths from sudden cardiac arrest. The debate hinges on precautionary measures.

The physical examination that virtually every athlete in the U.S. must pass to play a school sport includes listening to the heart, checking blood pressure and reviewing family medical history. Additional testing is typically not done unless a red flag is raised.

But many doctors strongly advocate adding an electrocardiogram, or EKG, to the pre-participation exam. They say it would detect about two-thirds of the deadly, concealed heart trouble aggravated by exercise in competition.

In other countries, most notably Italy, young athletes are required to have EKGs to play sports, but adopting the practice in the U.S. could cost $25 to $150 per EKG, which may not be covered by insurance.

At the Washington summit, the role of EKGs was hotly discussed. But when the conference created a national action plan for sports safety, the tests were not part of it. Many attendees felt that the focus on universal EKG screening was a distraction from more pertinent goals, like having lifesaving automatic external defibrillators, or AEDs, in every school in the country and near every playing field and gymnasium.

An AED, properly administered, can boost the survival rate after sudden cardiac arrest by 60 percent or more, but about 30 percent of schools do not have an AED.

David Wilganowski of Bryan, Tex., was a 17-year-old senior defensive lineman when his heart stopped and he collapsed during a game two years ago. Rudder High School's athletic trainer quickly performed CPR on Wilganowski and shocked his heart with an AED three times until it resumed beating. Doctors later attributed Wilganowski's episode to an undiagnosed heart condition and implanted a defibrillator in his chest.

He has not been permitted to resume his football career, but Wilganowski is studying engineering and recently completed his freshman year. "I'm lucky there was an AED there and someone who knew how to use it," Wilganowski said.

<p>In February, hundreds of youth sports safety advocates convened at a Washington hotel. They were determined to talk about something other than concussions, a counterintuitive ambition considering the rampant worry about the effects of head trauma in young athletes.</p><p>But the Washington group knew something most do not: the No. 1 killer of young athletes is sudden cardiac arrest, typically brought on by a pre-existing, detectable condition that could have been treated. Another substantial yet hidden lethal threat is heat stroke, a condition considered completely preventable.</p><p>A young athlete dies from a cardiac incident once every three days in the U.S., researchers say. In hot months like August, heat stroke often causes the death of a young athlete every other day on average.</p><p>Heat stroke has been a focus of sports safety advocates because of simple, common-sense preventive measures, like introducing gradual levels of exercise at the beginning of a sports season in hot temperatures.</p><p>Leaders of youth sports acknowledge that concussions have long been overlooked and that the injury deserves a period of heightened awareness, especially because of the potential for long-term consequences. But as the focus of the February conference organized by the National Athletic Trainers' Association suggests, there is a mounting worry that some hazardous health concerns are being disregarded.</p><p>One factor that may be inhibiting the conversation is a disagreement about the best course of action to reduce deaths from sudden cardiac arrest. The debate hinges on precautionary measures.</p><p>The physical examination that virtually every athlete in the U.S. must pass to play a school sport includes listening to the heart, checking blood pressure and reviewing family medical history. Additional testing is typically not done unless a red flag is raised.</p><p>But many doctors strongly advocate adding an electrocardiogram, or EKG, to the pre-participation exam. They say it would detect about two-thirds of the deadly, concealed heart trouble aggravated by exercise in competition.</p><p>In other countries, most notably Italy, young athletes are required to have EKGs to play sports, but adopting the practice in the U.S. could cost $25 to $150 per EKG, which may not be covered by insurance.</p><p>At the Washington summit, the role of EKGs was hotly discussed. But when the conference created a national action plan for sports safety, the tests were not part of it. Many attendees felt that the focus on universal EKG screening was a distraction from more pertinent goals, like having lifesaving automatic external defibrillators, or AEDs, in every school in the country and near every playing field and gymnasium.</p><p>An AED, properly administered, can boost the survival rate after sudden cardiac arrest by 60 percent or more, but about 30 percent of schools do not have an AED.</p><p>David Wilganowski of Bryan, Tex., was a 17-year-old senior defensive lineman when his heart stopped and he collapsed during a game two years ago. Rudder High School's athletic trainer quickly performed CPR on Wilganowski and shocked his heart with an AED three times until it resumed beating. Doctors later attributed Wilganowski's episode to an undiagnosed heart condition and implanted a defibrillator in his chest.</p><p>He has not been permitted to resume his football career, but Wilganowski is studying engineering and recently completed his freshman year. "I'm lucky there was an AED there and someone who knew how to use it," Wilganowski said.</p>